Monthly Archives: November 2007

I was unable to attend RSNA, but there are alway great advance made there every year. Here are a few things that cuaght my eye at the RSNA web site. there is plenty more check it out for yourself. If you went to RSNA let us know how it was I’d love to here some feedback thanks.

Helium-3 diffusion MRI differs from conventional MRI in that the patient inhales a specially prepared helium gas prior to imaging, and the scanner is adjusted to collect images showing this helium gas in tissue. MR measures how far the helium atoms move, or diffuse, inside the lungs during a specific time period – 1.5 seconds in this study. Using this method, radiologists and physicists can detect changes deep in the small airways and sacs in the lungs, which can break down, become enlarged and develop holes after prolonged exposure to cigarette smoke. Helium-3 diffusion MRI identifies this damage by measuring the increased distance the helium atoms move.

“With this technique, we are able to assess lung structure on a microscopic level,” Dr. Wang said.

For the study, measurements were translated into scores called apparent diffusion coefficient (ADC) values for each of the participants. An increased ADC value indicates that the helium atoms were able to travel farther during the measurement time. Fifty-seven percent of the smokers and 33 percent of the nonsmokers with high exposure to secondhand smoke had ADC values greater than 0.024, suggesting that early lung damage was present. In addition, 14 percent of smokers, 67 percent of high-exposure nonsmokers, and 39 percent of low-exposure nonsmokers had ADC values below 0.0185. Relatively low ADC values in adults are a possible indication of a developing respiratory problem, such as chronic bronchitis or asthma.

“These findings suggest that breathing secondhand smoke can injure your lungs,” Dr. Wang said. “Since legislation to limit public exposure to secondhand smoke is still being considered in many states, we hope that our work can be used to add momentum to the drive to pass such legislation.”

CHICAGO — Using a novel imaging technique to study autistic children, researchers have found increased gray matter in the brain areas that govern social processing and learning by observation. Results of the study conducted at the Fay J. Lindner Center for Autism, North Shore-Long Island Jewish Health System in Bethpage, N.Y., were presented today at the annual meeting of the Radiological Society of North America (RSNA).

“Our findings suggest that the inability of autistic children to relate to people and life situations in an ordinary way may be the result of an abnormally functioning mirror neuron system,” said lead author Manzar Ashtari, Ph.D., from the Children’s Hospital of Philadelphia in Pennsylvania.

Mirror neuronsare brain cells that are active both when an individual is performing an action and experiencing an emotion or sensation, and when that individual witnesses the same actions, emotions and sensations in others. First observed in the macaque monkey, researchers have found evidence of a similar system in humans that facilitates such functions as learning by seeing as well as doing, along with empathizing and understanding the intentions of others. Dr. Ashtari’s study found the autistic children had increased gray matter in brain regions of the parietal lobes implicated in the mirror neuron system.

The study included 13 male patients diagnosed with high-functioning autism or Asperger syndrome and an IQ greater than 70 and 12 healthy control adolescents. Average age of the participants was about 11 years. Each of the patients underwent diffusion tensor imaging (DTI), a technique that tracks the movement of water molecules in the brain.

DTI is traditionally used to study the brain’s white matter, as well as the brain fibers. However, Dr. Ashtari’s team applied it to the assessment of gray matter by employing apparent diffusion coefficient based morphometry (ABM), a new method that highlights brain regions with potential gray matter volume changes. By adding ABM to DTI, the researchers can detect subtle regional or localized changes in the gray matter.

In addition to the gray matter abnormalities linked to the mirror neuron system, the results of this study revealed that the amount of gray matter in the left parietal area correlated with higher IQs in the control group, but not in the autistic children.

“In the normal brain, larger amounts of gray matter are associated with higher IQs,” Dr. Ashtari said. “But in the autistic brain, increased gray matter does not correspond to IQ, because this gray matter is not functioning properly.”

The autistic children also evidenced a significant decrease of gray matter in the right amygdala region that correlated with severity of social impairment. Children with lower gray matter volumes in this area of the brain had lower scores on reciprocity and social interaction measures.

“Impairments in these areas are the hallmark of autism spectrum disorders, and this finding may lead to greater understanding of the neurobiological underpinnings of the core features of autism,” said study co-author Joel Bregman, M.D., medical director of the Fay J. Lindner Center for Autism.

Autism is the fastest growing developmental disability in the United States and typically appears during the first three years of life. Children with autism are hindered in the areas of social interaction and communication skills. According to the Centers for Disease Control and Prevention, as many as 1.5 million Americans have autism.

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These patients are too young. That is always my first thought when see the History and Physical. Sickle Cell Disease can be so destuctive to some patients. It can be a challanging managing these patients, since acurate diagnosis can be tricky with this disease. Sickle cell disease is a genetically transmitted autosomal recessive disorder in red blood cells. Instability of the hemoglobin molecule in the deoxygenated state, cuases red blood cells to change from the usual biconcave disc shape to an irregular sickled shape. The abnormal shape of these red blood cells and their propensity to adhere to the walls of blood vessels can occlude the vessels, preventing normal blood flow and decreasing the delivery of oxygen to organs and tissues, a condition known as crisis. The sickled cells are also extremely susceptible to hemolysis, causing individuals with sickle cell disease to have chronic anemia. sickle cell anemia – support group.

The skeletal manifestations of sickle cell disease are the result of changes in bone and bone marrow caused by the chronic tissue hypoxia that is exacerbated by episodic occlusion of the microcirculation by the abnormal sickle cells. The main processes that lead to bone and joint destruction in sickle cell disease are infarction of bone and bone marrow, compensatory bone marrow hyperplasia, secondary osteomyelitis, and secondary growth defects.

When the rigid erythrocytes jam in the arterial and venous sinusoids of skeletal tissue the resultant effect is intravascular thrombosis, which leads to infarction of bone and bone marrow. Repeated episodes of these crises eventually lead to irreversible bone infarcts and osteonecrosis especially in weight bearing areas. These areas of osteonecrosis (avascular necrosis/aseptic necrosis) become radiographically visible as sclerosis of bone with secondary reparative reaction and eventually result in degenerative bone and joint destruction.

These painful crises, which occur in almost all patients at some point in their lives, can last hours to days, affecting the bones of the back, the long bones, and the chest. Some patients have one episode every few years, while others have many episodes per year. The crises can be severe enough to require admission to the hospital for pain control and intravenous fluids.

Infarction usually occurs in a segmental pattern that suggests damage to the large cerebral arteries. The most common abnormalities found on arteriography or magnetic resonance angiography (MRA) are marked narrowing or complete occlusion of the anterior cerebral arteries (ACA) and/or middle cerebral arteries (MCA). Multiple, bilateral vessel involvement is usual, even in patients who have unilateral neurologic signs. Vessel narrowing is the consequence of intimal and medial proliferation that is thought to be caused by endothelial damage from sickled red blood cells. The damaged, irregular endothelium can serve as a nidus for the adhesion of platelets and sickle cells, thereby resulting in thrombus formation. The stroke event occurs when narrowing is severe enough to compromise distal flow or the thrombus dislodges and causes distal embolization. Transient neurologic symptoms can result from vessel spasm. Intracranial hemorrhage can be intracerebral or subarachnoid and can result from rupture of an aneurysm of the circle of Willis. Intracerebral hemorrhage may also occur years later in patients who had prior cerebral infarction as a result of a rupture of fragile collateral vessels (moyamoya).

The SILENT STROKE

Silent Stroke Is Not Detected With a Standard Neurologic Examination. To evaluate the sensitivity and specificity of neurologic examinations for detecting silent stroke, a pediatric neurologist examined four groups of children: 1) children with stroke detected with MRI but without focal neurologic findings (silent stroke); 2) children with stroke detected with MRI with focal neurologic findings (overt stroke); 3) children with sickle cell disease but no evidence of stroke with MRI; and 4) normal sibling controls. The division found the neurologic examination was not a sensitive method to detect a silent stroke; 34% of children with stroke as defined by MRI exhibited no focal neurologic findings [Glauser, 1995]. All children with a silent stroke had abnormal neurocognitive scores [Glauser, 1995].Common symptoms include:

Paleness

Susceptibility to infections

MRI is the best method for detecting early signs of osteonecrosis in patients with sickle cell disease and for identifying episodes of osteomyelitis

Nuclear scanning can also be used to detect early avascular necrosis. This modality also plays a role in detecting osteomyelitis. Likewise, indium leukocyte scanning has an important role in diagnosing osteomyelitis.

Patients with acute bone pain crises usually present with fever, leukocytosis, and warmth and tenderness around the affected joints. This process tends to affect the knees and elbows, mimicking rheumatic fever and septic arthritis. In adolescence and adulthood, the most prominent complication is osteonecrosis of 1 or more epiphyses, usually of the femoral or humeral heads. Chronic pain is often associated with later stages of osteonecrosis, particularly in the femoral head. Pain due to avascular necrosis is most notable with weight bearing on the joint. Patients often have pain associated with functional limitation of the affected joint.

Patients with sickle cell disease are prone to infection of the bone and bone marrow, or osteomyelitis, in areas of infarction and necrosis. Although Staphylococcus aureus is the most common cause of osteomyelitis in the general population, studies have shown that in patients with sickle cell disease the relative incidence of Salmonella osteomyelitis is twice that of staphylococcal infection

Treatment

Bone marrow transplant offers the only potential cure for sickle cell anemia. But very few people have a suitable donor for transplant.

As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. If you have sickle cell anemia, you’ll need to make regular visits to your doctor to check your red blood cell count and monitor your health. You may also require treatment from specialists at a hospital or sickle cell anemia clinic. Treatments may include medications to reduce pain and prevent complications, blood transfusions and supplemental oxygen, as well as bone marrow transplant.

Additional treatments may include:

Dialysis or kidney transplant for kidney disease

Drug rehabilitation and counseling for the psychological complications

Gallbladder removal (if there is significant gallstone disease)

Hip replacement for avascular necrosis of the hip (death of the joint)

Irrigation or surgery for priapism (persistent, painful erections)

Partial exchange transfusion for acute chest syndrome

Surgery for eye problems

Transfusions or surgery for brain problems, such as strokes

Wound care, zinc oxide, or surgery for leg ulcers

Medications

Medications used to treat sickle cell anemia include:

Antibiotics. Children with sickle cell anemia usually begin taking the antibiotic penicillin when they’re about 2 months of age and continue until they’re 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. Antibiotics may also help adults with sickle cell anemia fight certain infections.

Pain-relieving medications. To relieve pain during a sickle crisis, your doctor may advise over-the-counter pain relievers and application of heat to the affected area. You may also need stronger prescription painkillers.

Hydroxyurea (Droxia, Hydrea). This prescription drug, normally used to treat cancer, may be helpful for adults with severe disease. When taken daily, it reduces the frequency of painful crises and may reduce the need for blood transfusions. It seems to work by stimulating production of fetal hemoglobin — a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. There is some concern about the possibility that long-term use of this drug may cause tumors or leukemia in certain people. Your doctor can help you determine if this drug may be beneficial for you.

Blood transfusions

In a red blood cell transfusion, red blood cells are removed from a supply of donated blood. These donated cells are then given intravenously to a person with sickle cell anemia.

Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease their risk of stroke.

Blood transfusions carry some risk. Blood contains iron. Regular blood transfusions cause an excess amount of iron to build up in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions must often receive treatment to reduce iron levels. In 2005, the Food and Drug Administration approved deferasirox (Exjade), the first oral medication that can reduce excess iron levels, for use in people older than the age of 2.

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Lie detectors have been around for a long time, and have not always been acurate. We are at a technological turning point where we have the tools to look into the brain and tell conclusively if someone is lying. At Vanderbilt University neuroscientists are using FMRI to probe the inerworkings of the human brain, delving into reserch that will tell when you are lying or when you are in love.

The way FMRI works is by Measuring the flow of Oxygenated blood into areas of the brain showing the most activity, (neural activity). As blood flow to these areas increase the MRI machine can detect tiny differences in the magnetic properties of hemoglobin, (blood). All the data is reconstructed and the Radiologist can determine the area’s of the brain that are in use during the scan.

Darpa, the pentagon’s high-tech reserch department has been developing uses for FMRI. A recent article in the Cornell Law Review noted, “have developed technologies that may render the ‘dark art’ of interogation unneccessary”. This could lead to FMRI become a new Gold Standard for lie detecting . One company called NO-lie MRI is offering its FRMI based lie detecting services for $10,000 a scan. they have more than 100 potential clients that have expressed interest.

MRI may or may not be the solution, but as technology continues to progress we will see so many changes. MRI is like a new telescope into the mind and we are just starting to explore.We have so far to go.

• Truth Machine

• Proof of Purchase

• Big Love

For many, establishing guilt or innocence is fMRI’s holy grail.Study: Temple UniversityProtocol: Six graduate students were asked to fire a gun loaded with blanks, then lie about their actions. Five students who didn’t fire a gun were told to be truthful. Could fMRI scans reveal who was lying?Results: Fourteen areas of the brain, including the anterior cingulate cortex (top yellow dot) and the hippocampus (bottom), were active when subjects lied; seven areas were active when subjects told the truth.

One controversial use of fMRI is neuroeconomics —the study of mental and neural processes that drive economic decisions.Study: Carnegie Mellon University, Stanford University, MIT Sloan School of ManagementProtocol: Twenty-six adults were given $20 each to spend on consumer items. Could researchers predict intent to purchase based on brain regions registering activity?Results: When areas of the brain associated with product preference and evaluation of gains and losses—the nucleus accumbens (right red dot) and the medial prefrontal cortex (left), respectively—were activated, the person bought a product. Accuracy rate: 60 percent.

Love might be nothing more than a chemical reaction.Study: State University of New York, Stony Brook; Albert Einstein College of Medicine; Rutgers UniversityProtocol: Researchers asked 17 young men and women to look at photos of the people they professed to love, then analyzed their brain activity in an fMRI scanner.Results: Early stage romantic love is about motivation and reward, since it lights up subcortical reward regions like the right ventral tegmental area (top blue dot) and dorsal caudate area (bottom). Subjects in more extended romantic love showed more activity in the ventral pallidum (middle), which indicates attachment, in prairie voles—and, scientists surmise, in humans.

• The Oops Factor

• Better to Give

What happens when you make a costly mistake?Study: University of MichiganProtocol: Scientists asked 12 adults to complete 360 visually based tests that carried monetary rewards and penalties between 25 cents and $2.Results: When subjects made errors with consequences—in this case, losing money—the rostral anterior cingulate cortex (rACC, orange dot) was much more active. It was less active when mistakes carried no penalty. The rACC’s involvement suggests the importance of emotions in making decisions.

Does our brain think paying taxes is actually satisfying?Study: University of OregonProtocol: Scientists gave 19 women $100 each, then scanned their brains as they watched their money go to a charity, via mandatory taxation and voluntary contribution.Results: The caudate nucleus (right green dot) and nucleus accumbens (left), the same regions that fire when basic needs like hunger and social contact are met, were activated when subjects saw some of their tax money go to charity; activity was even greater when they gave money of their own accord. Scientists cite this as tentative proof of altruism.